NSG5003 Advanced Pathophysiology Midterm Exam 3 Questions and Answers (Graded A)
In examination of the nose, the clinician observes gray, pale mucous
... [Show More] membranes with clear, serous discharge. This is most likely indicative of:
Allergic rhinitis
Your patient complains of a feeling of heaviness in the lower legs daily. You note varicosities, edema, and dusky color of both ankles and feet. Which of the following is the most likely cause for these symptoms?
Venous insufficiency
Which of the following is the most important question to ask during cardiovascular health history?
Sudden death of a family member
Rheumatic heart disease is a complication that can arise from which type of infection?
Group A beta hemolytic streptococcus
A cough is described as chronic if it has been present for:
8 weeks or more
A key symptom of ischemic heart disease is chest pain. However, angina equivalents may include exertional dyspnea. Angina equivalents are important because:
A & B only
A woman with an X-linked dominant disorder will:
Transmit the disorder to 50% of her offspring (male or female)
A 55-year-old post-menopausal woman with a history of hypertension complains of jaw pain on heavy exertion. There were no complaints of chest pain. Her ECG indicates normal sinus rhythm without ST segment abnormalities. Your plan may include:
Exercise stress test
The aging process causes what normal physiological changes in the heart?
The heart valve thickens and becomes rigid, secondary to fibrosis and sclerosis
It is important to not dilate the eye if ____ is suspected
Acute closed-angle glaucoma
Your patient is a 78-year-old female with a smoking history of 120-pack years. She complains of hoarseness that has developed over the last few months. It is important to exclude the possibility of:
Laryngeal cancer
In examining the mouth of an older adult with a history of smoking, the nurse practitioner finds a suspicious oral lesion. The patient has been referred for a biopsy to be sent for pathology. Which is the most common oral precancerous lesion?
Leukoplakia
A 20-year-old engineering student complains of episodes of abdominal discomfort, bloating, and episodes of diarrhea. The symptoms usually occur after eating, and pain is frequently relieved with bowel movement. She is on a “celiac diet” and the episodic symptoms persist. Physical examination and diagnostic tests are negative. Colonoscopy is negative for any abnormalities. This is a history and physical consistent with:
Irritable bowel syndrome
The most common cause of eye redness is:
Conjunctivitis
In AR disorders, carriers have:
One copy of a gene mutation but not the disease
According to the Genetic Information Nondiscrimination Act (GINA):
All of the above
Aortic regurgitation requires medical treatment for early signs of CHF with:
ACE inhibitors
Which of the following is the most common cause of heartburn-type epigastric pain?
Decreased lower esophageal sphincter tone
The best way to diagnose structural heart disease/dysfunction non-invasively is:
Echocardiogram
Essential parts of a health history include all of the following except
Current vital signs
Men have faster and more efficient biotransformation of drugs and this is thought to be due to:
Answer is Testosterone (one option is repeated)
The main focus of treatment of patients with ACD is:
Management of the underlying disorder
A 72-year-old woman and her husband are on a cross-country driving vacation. After a long day of driving, they stop for dinner. Midway through the meal, the woman becomes very short of breath, with chest pain and a feeling of panic. Which of the following problems is most likely?
Pulmonary embolism
Your patient has been using chewing tobacco for 10 years. On physical examination, you observe a white ulceration surrounded by erythematous base on the side of his tongue. The clinician should recognize that very often this is:
Squamous cell carcinoma
The first assessment to complete related to the eyes is:
Visual acuity
A 66-year-old patient presents to the clinic complaining of dyspnea and wheezing. The patient reports a smoking history of 2 packs of cigarettes per day since age 16. This would be recorded in the chart as:
100-pack years
Which disease process typically causes episodic right upper quadrant pain, epigastric pain or chest pain that can last 4-6 hours or less, often radiates to the back (classically under the right shoulder blade) and is often accompanied by nausea or vomiting and often follows a heavy, fatty meal.
Cholecystitis
Which of the following conditions is the most common cause of nausea, vomiting, and diarrhea?
Viral gastroenteritis
Which of the following findings should trigger an urgent referral to a cardiologist or neurologist?
History of transient and painless monocular loss of vision
In order to provide a comprehensive genetic history of a patient, the NP should:
All of the above
Patients that have atopic disorders are mediated by the production of Immunoglobulin E (IgE) will have histamine stimulated as an immediate phase response. This release of histamine results in which of the following?
Question 31 options:
a)
Sinus pain, increased vascular permeability, and bronchodilation
Bronchospasm, vascular permeability, and vasodilatation
A 56-year-old male complains of anorexia, changes in bowel habits, extreme fatigue, and unintentional weight loss. At times he is constipated and other times he has episodes of diarrhea. His physical examination is unremarkable. It is important for the clinician to recognize the importance of: Colonoscopy
When all lab work is returned within normal limits, what is the most practical imaging study to order, considering cost, availability, and sensitivity?
Abdominal ultrasound
A common auscultatory finding in advanced CHF is:
S3 gallop rhythm
A nurse practitioner reports that your patient’s abdominal X-ray demonstrates multiple air-fluid levels in the bowel. This is a diagnostic finding found in:
Bowel Obstruction
The most common etiologic organism for community-acquired pneumonia is:
Streptococcus pneumoniae
What test is used to confirm the diagnosis of appendicitis? CT of abdomen with attention to appendix
A 76-year-old patient with a 200-pack year smoking history presents with complaints of chronic cough, dyspnea, fatigue, hemoptysis, and weight loss over the past 2 months. The physical exam reveals decreased breath sounds and dullness to percussion over the left lower lung field. The chest X-ray demonstrates shift of the mediastinum and trachea to the left. These are classic signs of:
Lung cancer
Jeff, 48 years old, presents to the clinic complaining of fleeting chest pain, fatigue, palpitations, lightheadedness, and shortness of breath. The pain comes and goes and is not associated with activity or exertion. Food does not exacerbate or relieve the pain. The pain is usually located under the left nipple. Jeff is concerned because his father has cardiac disease and underwent a CABG at age 65. The ANP examines Jeff and hears a mid-systolic click at the 4th ICS mid-clavicular area. The ANP knows that this is a hallmark sign of:
Mitral valve prolapse
Which of the following is considered a “red flag” when diagnosing a patient with pneumonia?
Pleural effusion on chest X-ray
Mr. Keenan is a 42-year-old man with a mild history of GERD and a remote history of an appendectomy, presenting with an acute onset of significant right upper-quadrant abdominal pain and vomiting. His pain began after a large meal, was unrelieved by a proton-pump inhibitor, was unlike his previous episodes of heartburn, but upon questioning, reports milder, prodromal episodes of similar post-prandial pain. His pain seems to radiate to his back. Despite a family history of cardiac disease, he reports no classic anginal signs or chest pain. He furthermore denies respiratory or pleuritic signs and denies fever, night sweats, and unintended weight loss. Finally, there are no dermatologic signs, nor genitourinary symptoms.
Abdominal plain films
In addition to the complete blood count (CBC) with differential, which of the following laboratory tests is considered to be most useful in diagnosing ACD and IDA?
Serum ferritin
What is the most common valvular heart disease in the older adult?
Aortic stenosis
Iron Deficiency Anemia (IDA) is classified as a microcytic, hypochromic anemia. This classification refers to which of the following laboratory data?
Mean Corpuscular Volume (MCV) and Mean Corpuscular Hemoglobin (MCH)
A 22-year-old female comes to your office with complaints of right lower quadrant abdominal pain, which has been worsening over the last 24 hours. On examination of the abdomen, there is a palpable mass and rebound tenderness over the right lower quadrant. The clinician should recognize the importance of:
Pelvic examination
Which of the following details are NOT considered while staging asthma?
Long-acting beta agonist usage
Dan G., a 65-year-old man, presents to your primary care office for the evaluation of chest pain and left-sided shoulder pain. Pain begins after strenuous activity, including walking. Pain is characterized as dull, aching; 8/10 during activity, otherwise 0/10. Began a few months ago, intermittent, aggravated by exercise, and relieved by rest. Has occasional nausea. Pain is retrosternal, radiating to left shoulder, definitely affects quality of life by limiting activity. Pain is worse today; did not go away after he stopped walking. BP 120/80. Pulse 72 and regular. Normal heart sounds, S1 and S2, no murmurs. Which of the following differential diagnoses would be most likely?
Coronary artery disease with angina pectoris
The following criterion is considered a positive finding when determining whether a patient with asthma can be safely monitored and treated at home:
Tachypnea greater than 30 breaths/minute
Your 2-year-old patient shows facial features, such as epicanthal folds, up-slanted palpebral fissures, single transverse palmar crease, and a low nasal bridge. These are referred to as:
Dysmorphic features related to genetic disease
A 26-year-old, non-smoker, male presented to your clinic with SOB with exertion. This could be due to:
Alpha-1 deficiency
Your patient has been treated for glaucoma for 5 years. Which of the following will provide indication of the level of progression during the funduscopic examination for this patient?
Estimating cup-to-disk ratio
Which of the following medications are commonly associated with the side effect of cough?
ACE inhibitor
When interpreting laboratory data, you would expect to see the following in a patient with Anemia of Chronic Disease (ACD):
Ans is Hemoglobin <12 g/dl, MCV normal, MCH normal option missing
The first step in the genomic assessment of a patient is obtaining information regarding:
Family history
In assessing the eyes, which of the following is considered a “red flag” finding when associated with eye redness?
Grossly visible corneal defect
During physical examination of a patient, you note resonance on percussion in the upper lung fields. This is consistent with:
A normal finding
Which test is the clinical standard for the assessment of aortic stenosis?
Echocardiography
Which of the following would be considered a “red flag” that requires more investigation in a patient assessment?
Myocardial infarction in family member at age 35
When counseling clients regarding the use of antidiarrheal drugs such as Imodium anti-diarrheal and Kaopectate, the nurse practitioner advises patients to:
Do not use for possible infectious diarrhea
Which of the following imaging studies should be considered if a pulmonary malignancy is suspected?
Computed tomography (CT) scan
A 75-year-old patient complains of pain and paresthesias in the right foot that worsens with exercise and is relieved by rest. On physical examination you note pallor of the right foot, capillary refill of 4 seconds in the right foot, +1 dorsalis pedis pulse in the right foot, and +2 pulse in left foot. Which of the following is a likely cause of the signs and symptoms?
Arterial insufficiency
Emphysematous changes in the lungs produce the following characteristic in COPD patients?
Increased anterior-posterior diameter
Which of the following findings would indicate a need for another endoscopy in clients with peptic ulcer disease?
Symptoms persisting after six to eight weeks of therapy
Your patient has just returned from a 6-month missionary trip to Southeast Asia. He reports unremitting cough, hemoptysis, and an unintentional weight loss of 10 pounds over the last month. These symptoms should prompt the clinician to suspect:
Tuberculosis
The cytochrome p system involves enzymes that are generally:I
nhibited or induced by drugs
Functional abilities are best assessed by:
Observed assessment of function
Epistaxis can be a symptom of:
All of the above
Which of the following is not a contributing factor to the development of esophagitis in older adults?
Increased gastric emptying time
A 24-year-old patient presents to the emergency department after sustaining multiple traumatic injuries after a motorcycle accident. Upon examination, you note tachypnea, use of intercostal muscles to breathe, asymmetric chest expansion, and no breath sounds over the left lower lobe. It is most important to suspect:
Pneumothorax
You have a patient complaining of vertigo and want to know what could be the cause. Knowing there are many causes for vertigo, you question the length of time the sensation lasts. She tells you several hours to days and is accompanied by tinnitus and hearing loss. You suspect which of the following conditions?
Ménière’s disease
An 82-year-old female presents to the emergency department with epigastric pain and weakness. She admits to having dark, tarry stools for the last few days. She reports a long history of pain due to osteoarthritis. She self-medicates daily with ibuprofen, naprosyn, and aspirin for joint pain. On physical examination, she has orthostatic hypotension and pallor. Fecal occult blood test is positive. A likely etiology of the patient’s problem is:
Gastric ulcer
The major impact of the physiological changes that occur with aging is:
All of the above
The pathophysiological hallmark of ACD is:
Impaired ability to use iron stores
Which symptom is more characteristic of Non-Cardiac chest pain?
Pain tends to occur with movement, stretching or palpation
A 23-year-old patient who has had bronchiectasis since childhood is likely to have which of the following:
Clubbing
Upon assessment of respiratory excursion, the clinician notes asymmetric expansion of the chest. One side expands greater than the other. This could be due to:
Pneumothorax
A specific exam used to evaluate the gall bladder is:
Murphy’s sign
A 64-year-old male presents with erythema of the sclera, tearing, and bilateral pruritus of the eyes. The symptoms occur intermittently throughout the year and he has associated clear nasal discharge. Which of the following is most likely because of the inflammation?
Allergen
Your patient complains of lower abdominal pain, anorexia, extreme fatigue, unintentional weight loss of 10 pounds in last 3 weeks, and you find a positive hemoccult on digital rectal examination. Laboratory tests show iron deficiency anemia. The clinician needs to consider:
Colon cancer
During auscultation of the chest, your exam reveals a loud grating sound at the lower anterolateral lung fields, at full inspiration and early expiration. This finding is consistent with:
Pneumonia, Pleuritis [Show Less]